Fire's effects often hardest on children

January 31, 1996|By Douglas Birch | Douglas Birch,SUN STAFF

Fire can inflict terrible injuries on anyone, but no one is more vulnerable than a child.

A house fire can generate air temperatures of 500 degrees Fahrenheit or more, hot enough to sear a victim's throat and make it swell shut. But it can be hard to tell when a child is suffocating from throat burns, said Dr. Julius Goepp, assistant director of the pediatric emergency department at Johns Hopkins Children's Center. "Children are very, very strong," said Dr. Goepp, who treated one of yesterday's victims in an East Baltimore rowhouse fire. "They can look much better than they really are."

In third-degree burns, flames destroy every layer of skin and expose the muscle, fat or bone to the air. The body loses fluids from the bloodstream with astonishing speed. Without the insulation that skin provides, the body's core temperature can plummet.

The loss of substantial amounts of fluid or heat can kill within minutes.

Children are especially susceptible to fluid and heat loss, Dr. Goepp said. That's because they have more skin area per pound than adults and therefore more surface area -- relative to their size -- from which fluids can evaporate and heat can escape.

Children also succumb quickly to smoke inhalation; most child deaths in fires occur at the scene of the blaze, because of poisoning from carbon monoxide and other toxic gases in the smoke.

The most critical period for burn victims, Dr. Goepp said, is the first two hours after the blaze. If the victim survives beyond 24 hours, the biggest long-term threat comes from the loss of skin's ability to shield against infection.

People with third-degree burns are generally not in agony, because the fire has destroyed the nerves along with the skin. "They're painless," Dr. Goepp said.